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Nebraska rates for HCPCS 90696

Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $67.61 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $74.13 / $120.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $52.48 / $64.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $173.78 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $70.79 / $75.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $70.79 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $70.79 / $75.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $251.19 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $70.79 / $79.43